Background: Primary dysmenorrhea (PD) is a common gynecological problem among women of reproductive age. The acute recurring pain associated with PD can negatively impact quality of life (QoL), and impair physical functioning and sleep. Alongside pharmacological interventions, physiotherapy interventions are also commonly employed by women with PD. The aim of this thesis was to investigate the effectiveness of physiotherapy interventions, including aerobic exercise, for the management of PD.

Methods: The framework of the thesis is based on the Medical Research Council guidelines for developing and evaluating complex interventions. The development phase included a systematic review to investigate the effectiveness of physiotherapy interventions on pain and QoL. Subsequently, a narrative review was conducted to identify the physiological mechanisms underlying these physiotherapy interventions for pain relief in women with PD. The feasibility phase included a study (N=10) to assess the feasibility and safety of a treadmill-based exercise intervention for women with PD. The feasibility study also provided data for power estimation for the main randomised controlled trial (RCT). The evaluation phase included a RCT (N=70) to determine the effectiveness of a treadmill-based exercise intervention on pain, QoL, physical functioning, and sleep in women with PD. Participants’ perception of global improvement following the intervention was also measured.

Results: The systematic review identified acupuncture and acupressure, compared to no treatment control, as effective interventions for managing PD-associated pain. Transcutaneous electrical nerve stimulation, heat, and yoga were also found to be effective. However, the results for these interventions were interpreted with caution as they were from single, small, and underpowered studies. The narrative review identified endogenous opioid and gate control mechanisms as the primary physiological mechanisms underlying physiotherapy interventions for pain modulation in women with PD. The feasibility study provided evidence suggesting the treadmill-based exercise intervention as feasible and safe for women with PD. Excellent adherence and retention were reported in the feasibility study. The RCT demonstrated that three weeks of supervised aerobic exercise supplemented with a further 28 weeks of unsupervised aerobic exercise was significantly effective for decreasing pain and improving QoL and physical functioning in women with PD. Clinically significant improvement in pain intensity was reported with continuing the aerobic exercise programme for 28 weeks. Participants reported their perception of global improvement following intervention as “improved” which is considered a clinically significant change. Excellent adherence and retention were also reported in the RCT. However, the RCT identified no beneficial effects of aerobic exercise on sleep in women with PD.

Conclusions: This research has presented evidence for the effectiveness of a treadmill-based exercise intervention for the management of PD. In addition, the current thesis adds to the body of evidence surrounding the use of physiotherapy interventions on PD-associated pain. The results of this thesis has provided clinicians and researchers with new insights, knowledge, and evidence regarding the effectiveness of physiotherapy interventions, including aerobic exercise, for the management of PD.